The Environment and Children’s Health Care in Northwest China

BMC Pediatrics

Qingshan Qu¹  Yu Chen³  Alan Mendelsohn³  Lung-Chi Chen¹  Xiaobin Hu⁴  Meichi Chen⁴  Yingbiao Sun⁴  Guowu Ding⁴  Zhilan Li⁴  Benzhong Zhang⁴  Xingrong Liu⁴  Juansheng Li⁴  Jingping Niu⁴  Leonardo Trasande² 

[1] Department of Environmental Medicine, New York University School of Medicine, New York, USA;NYU Steinhardt School of Culture, Education and Human Development, Department of Nutrition, Food & Public Health, New York, NY, USA;Department of Population Health, University School of Medicine, New York, NY, USA;Lanzhou University School of Public Health, Lanzhou, Gansu, China

关键词: Industrializing world;    Air pollution;    Survey;    Self-efficacy;    Practice;    Children’s environmental health;   

Others  :  1138940
DOI  :  10.1186/1471-2431-14-82

 received in 2013-10-28, accepted in 2014-03-21,  发布年份 2014

【 摘 要 】

Background

Industrialization in the northwest provinces of the People’s Republic of China is accelerating rapid increases in early life environmental exposures, yet no publications have assessed health care provider capacity to manage common hazards.

Methods

To assess provider attitudes and beliefs regarding the environment in children’s health, determine self-efficacy in managing concerns, and identify common approaches to managing patients with significant exposures or environmentally-mediated conditions, a two-page survey was administered to pediatricians, child care specialists, and nurses in five provinces (Gansu, Shaanxi, Xinjiang, Qinghai, and Ningxia). Descriptive and multivariable analyses assessed predictors of strong self-efficacy, beliefs or attitudes.

Results

960 surveys were completed with <5% refusal; 695 (72.3%) were valid for statistical analyses. The role of environment in health was rated highly (mean 4.35 on a 1-5 scale). Self-efficacy reported with managing lead, pesticide, air pollution, mercury, mold and polychlorinated biphenyl exposures were generally modest (2.22-2.52 mean). 95.4% reported patients affected with 11.9% reporting seeing >20 affected patients. Only 12.0% reported specific training in environmental history taking, and 12.0% reported owning a text on children’s environmental health. Geographic disparities were most prominent in multivariable analyses, with stronger beliefs in environmental causation yet lower self-efficacy in managing exposures in the northwestern-most province.

Conclusions

Health care providers in Northwest China have strong beliefs regarding the role of environment in children’s health, and frequently identify affected children. Few are trained in environmental history taking or rate self-efficacy highly in managing common hazards. Enhancing provider capacity has promise for improving children’s health in the region.

【 授权许可】

   
2014 Trasande et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Guimaraes J, Ikingura J, Akagi H: Methyl mercury production and distribution in river water-sediment systems investigated through radiochemical techniques. Water Air Soil Pollut 2000, 124(1–2):113-124.
• [2]Feng X, Li P, Qiu G, Wang S, Li G, Shang L, Meng B, Jiang H, Bai W, Li Z, Fu X: Human Exposure To Methylmercury through Rice Intake in Mercury Mining Areas, Guizhou Province, China. Environ Sci Tech 2007, 42(1):326-332.
• [3]Zhang H, Feng X, Larssen T, Qiu G, Vogt RD: In Inland China, Rice, Rather than Fish, Is the Major Pathway for Methylmercury Exposure. Environ Health Perspect 2010, 118:9.
• [4]Zhang S-M, Dai Y-H, Xie X-H, Fan Z-Y, Tan Z-W, Zhang Y-F: Surveillance of Childhood Blood Lead Levels in 14 Cities of China in 2004-2006. Biomed Environ Sci 2009, 22(4):288-296.
• [5]He K, Wang S, Zhang J: Blood lead levels of children and its trend in China. Sci Total Environ 2009, 407(13):3986-3993.
• [6]Huo X, Peng L, Xu X, Zheng L, Qiu B, Qi Z, Zhang B, Han D, Piao Z: Elevated blood lead levels of children in Guiyu, an electronic waste recycling town in China. Environ Health Perspect 2007, 115(7):1113.
• [7]LaFraniere S: Lead Poisoning in China: The Hidden Scourge. New York Times 2011, A1.
• [8]Trasande L, Thurston GD: The role of air pollution in asthma and other pediatric morbidities. J Allergy Clin Immunol 2005, 115(4):689-699.
• [9]Thurlbeck WM: Postnatal human lung growth. Thorax 1982, 37(8):564-571.
• [10]Roy A, Sheffield P, Wong K, Trasande L: The effects of outdoor air pollutants on the costs of pediatric asthma hospitalizations in the United States, 1999 to 2007. Med Care 2011, 49(9):810-817.
• [11]Sheffield P, Roy A, Wong K, Trasande L: Fine Particulate Matter Pollution Linked To Respiratory Illness In Infants And Increased Hospital Costs. Health Aff 2011, 30(5):871-878.
• [12]Goodman D: The Campaign to ‘Open Up the West’: National, Provincial-level and Local Perspectives. In China’s Campaign to “Open Up the West”: National, Provincial- level and Local Perspectives. Edited by Goodman DSG. Cambridge: Cambridge University Press; 2004:8-9.
• [13]Chaolin G, Jianfa S, Taofang Y: Urban and Regional Development. In Developing China’s West: A critical Path to Balanced National Development. Edited by ShenJianfa YMY. Hong Kong: The Chinese University Press; 2004:182.
• [14]Kilpatrick N, Frumkin H, Trowbridge J, Escoffery C, Geller R, Rubin L, Teague G, Nodvin J: The Environmental History in Pediatric Practice: A Study of Pediatricians’ Attitudes, Beliefs, and Practices. Environ Health Perspect 2002, 110(8):823-827.
• [15]Trasande L, Boscarino J, Graber N, Falk R, Schechter C, Galvez M, Dunkel G, Geslani J, Moline J, Kaplan-Liss E, Miller RK, Korfmacher K, Carpenter D, Forman J, Balk SJ, Laraque D, Frumkin H, Landrigan P: The environment in pediatric practice: a study of New York pediatricians’ attitudes, beliefs, and practices towards children’s environmental health. J Urban Health 2006, 83(4):760-772.
• [16]Trasande L, Cronk CE, Leuthner SR, Hewitt JB, Durkin MS, McElroy JA, Anderson HA, Landrigan PJ: The National Children’s Study and the children of Wisconsin. WMJ 2006, 105(2):50-54.
• [17]Trasande L, Ziebold C, Schiff JS, Wallinga D, McGovern P, Oberg CN: The Environment in Pediatric Practice in Minnesota: Attitudes, Beliefs, and Practices towards Children’s Environmental Health. Minnesota: Minnesota Medicine, submitted; 2008.
• [18]Trasande L, Newman N, Long L, Howe G, Kerwin BJ, Martin RJ, Gahagan SA, Weil WB: Translating Knowledge About Environmental Health to Practitioners: Are We Doing Enough? Mt Sinai J Med 2010, 77(1):114-123.
• [19]Beaudet NJ, Alcedo GC, Nguyen QC, Jacoby D, Kieu Q, Karr CJ: Children’s Environmental Health Experience and Interest Among Pediatric Care Providers in Vietnam. J Health Pollut 2011, 1(2):24-36.
• [20]Zonfrillo MRMDM, Wiebe DJP: Survey Science in Pediatric Emergency Medicine. Pediatr Emerg Care 2011, 27(5):443-448.
• [21]Arita A, Niu J, Qu Q, Zhao N, Ruan Y, Nadas A, Chervona Y, Wu F, Sun H, Hayes RB, Costa M: Global levels of histone modifications in peripheral blood mononuclear cells of subjects with exposure to nickel. Environ Health Perspect 2012, 120(2):198-203.
• [22]The China Perspective: Qinghai Province. 2013. Available at http://www.thechinaperspective.com/topics/province/qinghai-province/ webcite (Accessed 12 July 2013)
• [23]The China Perspective: Ningxia Hui province. 2013. Available at http://thechinaperspective.com/topics/province/ningxia-hui-autonomous-region/ webcite (accessed 12 july 2013)